scholarly journals Chemical peritonitis associated with intraperitoneal vancomycin: A case series

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
José Silvano ◽  
◽  
Luciano Pereira ◽  
Ana Oliveira ◽  
Ana Beco ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Drug Withdrawal ◽  
Clinical Course ◽  
Leukocyte Count ◽  
Case Series ◽  
Aseptic Technique ◽  
Drug Challenge ◽  
Chemical Peritonitis ◽  
Culture Negative

Peritonitis is a serious complication in peritoneal dialysis, usually secondary to an infectious cause. Chemical peritonitis is rarer. No case exclusively attributed to vancomycin has been reported in the last 20 years. Data from 4 consecutive patients diagnosed with culture -negative peritonitis following administration of intraperitoneal vancomycin between May and June 2019 were retrospectively recorded. All patients were treated with 2 grams of intraperitoneal vancomycin after a break in aseptic technique and developed a cloudy effluent. No patient was previously known to be allergic to vancomycin. All had a clear dialysate before vancomycin. All developed an elevated leukocyte count in the dialysate. All had sterile cultures. All resumed a clear effluent with less <100 cells/μL after vancomycin cessation, and in two there were no further administrations. In one, a new drug challenge led to recrudescence of abdominal pain and reappearance of a cloudy sterile effluent. In another, vancomycin from a different lot was administrated 3 days after, no symptoms developed and dialysate cell count remained normal. The pathogenic mechanisms underlying chemical peritonitis are not fully known. The clinical course is typically benign. Management seems to be limited to drug withdrawal. If unrecognized, chemical peritonitis may ultimately lead to unnecessary catheter removal.

scholarly journals COVID-19 in Hospitalized Patients on Chronic Peritoneal Dialysis: A Case Series

2020 ◽  
Vol 51 (8) ◽  
pp. 669-674 ◽  
Author(s):  
Mala Sachdeva ◽  
Nupur N. Uppal ◽  
Jamie S. Hirsch ◽  
Jia H. Ng ◽  
Deepa Malieckal ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Course ◽  
Case Series ◽  
The United States ◽  
Hospitalized Patients ◽  
End Stage Kidney Disease ◽  
Entire Cohort ◽  
End Stage ◽  
Culture Negative ◽  
Descriptive Statistical Analysis

Background: The COVID-19 pandemic has affected the end-stage kidney disease (ESKD) population, with high mortality rates reported among patients on hemodialysis. However, the degree to which it has affected the peritoneal dialysis (PD) population in the United States has not yet been elucidated. In this report, we describe the clinical characteristics, presentations, clinical course, and outcomes of ESKD patients on PD hospitalized with COVID-19. Methods: We describe the characteristics, presentation, and outcomes of adult ESKD patients on chronic PD hospitalized with CO­VID-19 in our 13 major hospitals in the NY health system using descriptive statistical analysis. Results: Of 419 hospitalized patients with ESKD, 11 were on chronic PD therapy (2.6%). Among those 11, 3 patients required mechanical ventilation, 2 of whom died. Of the entire cohort, 9 of the 11 patients (82%) were discharged alive. While fever was a common presentation, more than half of our patients also presented with diarrhea. Interestingly, 3 patients were diagnosed with culture-negative peritonitis during their hospitalization. Seven patients reported positive SARS-CoV-2 exposure from a member of their household. Conclusion: Hospitalized patients on PD with COVID-19 had a relatively mild course, and majority of them were discharged home.

Culture-Negative Peritonitis Associated with the use of Icodextrin-Containing Dialysate in Twelve Patients Treated with Peritoneal Dialysis

2003 ◽  
Vol 23 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Walther H. Boer ◽  
Pieter F. Vos ◽  
Marien W.J.A. Fieren
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
University Hospital ◽  
Differential Count ◽  
Antibiotic Resistant ◽  
Dialysis Unit ◽  
Leukocyte Counts ◽  
Chemical Peritonitis ◽  
Culture Negative ◽  
Hospital Center

← Background In the first half of the year 2001, an unusually large number of culture-negative peritonitis episodes occurred in Center A. One patient noticed that his culture-negative antibiotic-resistant peritonitis promptly cleared after inadvertently stopping the use of icodextrin-containing dialysate, but recurred immediately after using icodextrin again. This observation led to the recognition of eight contemporaneous cases of icodextrin-induced culture-negative peritonitis in Center A, and identification of three additional cases in Center B. ← Design Case studies in 12 patients. ← Setting Peritoneal dialysis unit of a university hospital and an affiliated unit (Center A), and a second university hospital (Center B). ← Patients 12 patients on peritoneal dialysis presenting with culture-negative peritonitis. ← Results At presentation, abdominal pain was absent or mild and dialysate leukocyte counts were moderately elevated (approximately 100 – 1500 cells/mm3). Differentiation of the dialysate leukocytes showed a low fraction of neutrophils (approximately 35%). In eight cases, the evidence that the peritonitis was caused by icodextrin was very strong (the clinical picture and laboratory results mentioned above, unresponsiveness to antibiotic therapy, cure after withdrawal of icodextrin, relapse after rechallenge); in 3 patients, the evidence was strong (as in the cases mentioned above, but no rechallenge was performed). Stopping icodextrin promptly relieved the symptoms and normalized the dialysate leukocyte counts. After rechallenge, a relapse invariably occurred, usually within a few days. In one case, the evidence was circumstantial. ← Conclusion Our findings are compatible with icodextrin-induced peritonitis. This entity is characterized by mild abdominal pain at presentation, a moderate dialysate leukocytosis with a low fraction of neutrophils in the differential count, and resistance to antibiotic treatment. Speculations about the pathogenesis of this type of peritonitis include chemical peritonitis due to a contaminating substance or hypersensitivity to icodextrin.

Peritoneal dialysis-associated peritonitis caused by Enterococcus avium

2021 ◽  
Vol 14 (3) ◽  
pp. e240272
Author(s):  
Rita Calça ◽  
Francisca Gomes da Silva ◽  
Ana Rita Martins ◽  
Patrícia Quadros Branco
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Antibiotic Therapy ◽  
Rare Case ◽  
Clinical Course ◽  
Catheter Removal ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Laboratory Findings ◽  
Microbial Agents

Peritonitis remains a common and serious complication of peritoneal dialysis. Peritonitis caused by gram-positive organisms includes coagulase-negative staphylococci, Streptococcus spp and Enterococcus spp. We present a rare case of peritoneal dialysis-associated peritonitis, where persisting abdominal pain and worsening laboratory findings despite antibiotic therapy led to the identification of Enterococcus avium, requiring Tenckoff catheter removal and temporary transfer to haemodialysis. The available literature reports only few cases where peritonitis is caused by this agent, underlining the need to consider atypical microbial agents when heterogeneous clinical course is presented.

Effluent lipopolysaccharide is a prompt marker of peritoneal dialysis-related gram-negative peritonitis

2020 ◽  
Vol 40 (5) ◽  
pp. 455-461
Author(s):  
Hao Yan ◽  
Dahua Ma ◽  
Shuang Yang ◽  
Zhaohui Ni ◽  
Wei Fang
Keyword(s):  
Peritoneal Dialysis ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Leukocyte Count ◽  
The Other ◽  
Cutoff Value ◽  
Gram Negative ◽  
Lower Blood ◽  
Blood Leukocyte ◽  
Culture Negative

Background: To investigate the value of effluent lipopolysaccharide (LPS) for early detection of gram-negative peritonitis (GNP) in peritoneal dialysis (PD) patients. Methods: PD-related peritonitis episodes occurring between January 2016 and December 2018 were included in the study. Effluent LPS and the other infectious parameters were measured at peritonitis presentation, and peritonitis was categorized as GNP, non-GNP, and culture-negative peritonitis. Receiver operating characteristic (ROC) analysis was employed to evaluate the efficacy of effluent LPS to distinguish GNP. Results: A total of 161 peritonitis episodes were analyzed, including 49 GNP episodes and 82 non-GNP episodes. In contrast with non-GNP, GNP presented with higher effluent leukocyte count (3236 (1497–6144) vs. 1904 (679–4071) cell mm−3, p = 0.008), increased effluent LPS (1.552 (0.502–2.500) vs. 0.016 (0.010–0.030) EU mL−1, p < 0.001), lower blood leukocyte count (9.95 ± 3.18 vs. 11.56 ± 4.37 × 109 L−1, p = 0.017), greater neutrophil predominance (87.1 ± 4.6% vs. 83.4 ± 7.7%, p = 0.001), and greater “procalcitonin” (PCT, 4.90 (2.20–12.60) vs. 1.00 (0.51–4.07) µg L−1, p < 0.001). It took 5.2 ± 3.1 h to report the results of effluent LPS. Effluent LPS cutoff value of >0.035 EU mL−1 showed an area under the ROC curve of 0.972 (95% CI 0.951–0.994, p < 0.001) in differentiating GNP from non-GNP with a sensitivity of 100% and a specificity of 80.5%, and its joint utilization with PCT further increased the specificity (91.4%) to discriminate GNP. Conclusions: PD effluent LPS could be an applicable early marker of gram-negative organism-related peritonitis in PD patients.

Gallbladder Stones, Cholecystitis and Cholecystectomy in Patients on Continuous Ambulatory Peritoneal Dialysis

1984 ◽  
Vol 4 (4) ◽  
pp. 245-248 ◽  
Author(s):  
William Nelson ◽  
Ramesh Khanna ◽  
Raymond Mathews ◽  
Harry Yeung ◽  
George Wu ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Ultrasound Examination ◽  
Clinical Course ◽  
Gallbladder Disease ◽  
Abdominal Ultrasound ◽  
Toronto Western Hospital ◽  
The Past ◽  
Possible Cause ◽  
Abdominal Ultrasound Examination

This paper describes a prospective three-year study using abdominal ultrasound examination in 114 new CAPD patients. Gallbladder disease was common (22.8%) and four of 16 patients with gallstones (25%) required cholecystectomy after 1–14 (i 7.8 months) on CAPD. Two of these four had evidence of peritonitis in association with cholecystitis. Also we analyzed the clinical course of eight patients on chronic PD who underwent cholecystectomy. They had no serious morbidity, and all returned to chronic PD. While abdominal pain is one of the main features of CAPD-related peritonitis, other causes of abdominal pain may be more difficult to evaluate in the patient on peritoneal dialysis (PD); such causes potentially are more serious because they threaten the continuance of PD as a mode of therapy. Cholecystitis related to cholelithiasis is one such possible cause of abdominal pain. However, since ultrasonography can reliably and non-invasively detect the presence of gallstones, we have used it prospectively to screen patients entering our CAPD training program. This paper reports our findings and the subsequent course of those found to have gallstones during a three-year period. In addition we also reviewed the feasibility of cholecystectomy, its hazards and outcome in eight patients on chronic peritoneal dialysis who underwent this procedure at Toronto Western Hospital in the past seven years.

Mycobacterium Chelonei Peritonitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dial ysis (CAPD)

1983 ◽  
Vol 3 (2) ◽  
pp. 86-88 ◽  
Author(s):  
Michel Poisson ◽  
Vincent Beroniade ◽  
Pierre Falardeau ◽  
Carlos Vega ◽  
Richard Morisset
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Antimicrobial Therapy ◽  
Tap Water ◽  
Mycobacterial Infection ◽  
Gram Stain ◽  
Bacterial Peritonitis ◽  
Aerobic And Anaerobic ◽  
Culture Negative

This paper describes a case of Mycobacterium chelonei peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). The patient probably acquired the infection from tap water. He presented with cloudy effluent, abdominal pain and systemic toxicity. Originally, gram stain, Ziehl-Neelsen stain, aerobic and anaerobic cultures were negative. One week later, culture grew an aerobic, fast growing, acid fast bacterium, which later was identified as Mycobacterium chelonei. The peritonitis was treated successfully with erythromycin and catheter removal. The diagnosis of tuberculous and non-tuberculous mycobacterial peritonitis during CAPD can be difficult. Compared to usual bacterial peritonitis associated with CAPD, everything in these cases proves to be nonspecific. Mycobacterial infection should be suspected in all episodes of culture-negative peritonitis especially those which do not respond to usual antimicrobial therapy.

The clinical course of rapidly growing nontuberculous mycobacterial peritoneal dialysis infections in Asians: A case series and literature review

Nephrology ◽  
2011 ◽  
Vol 16 (2) ◽  
pp. 174-179 ◽  
Author(s):  
CLAUDE J RENAUD ◽  
SRINIVASAN SUBRAMANIAN ◽  
PAUL A TAMBYAH ◽  
EVAN JC LEE
Keyword(s):  
Peritoneal Dialysis ◽  
Literature Review ◽  
Clinical Course ◽  
Case Series

scholarly journals Clinical Characteristics and Outcomes of “Silent” and “Non-Silent” Peritonitis in Patients on Peritoneal Dialysis

2013 ◽  
Vol 33 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Jie Dong ◽  
Suping Luo ◽  
Rong Xu ◽  
Yuan Chen ◽  
Ying Xu
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Treatment Failure ◽  
Clinical Characteristics ◽  
Cell Counts ◽  
Daily Energy ◽  
Baseline Values ◽  
Gram Negative Organisms ◽  
Pain Patients ◽  
Culture Negative

♦ObjectivesWe compared the clinical characteristics and outcomes of “silent” peritonitis (meaning episodes without fever and abdominal pain) and “non-silent” peritonitis in patients on peritoneal dialysis (PD).♦MethodsOur cohort study collected data about all peritonitis episodes occurring between January 2008 and April 2010. Disease severity score, demographics, and biochemistry and nutrition data were recorded at baseline. Effluent cell counts were examined at regular intervals, and the organisms cultured were examined. Treatment failure was defined as peritonitis-associated death or transfer to hemodialysis.♦ResultsOf 248 episodes of peritonitis occurring in 161 PD patients, 20.9% led to treatment failure. Of the 248 episodes, 51 (20.6%) were not accompanied by fever and abdominal pain. Patients with these silent peritonitis episodes tended to be older ( p = 0.003). The baseline values for body mass index, triglycerides, and daily energy intake were significantly lower before silent peritonitis episodes than before non-silent episodes ( p = 0.01, 0.003, and 0.001 respectively). Although silent peritonitis episodes were more often culture-negative and less often caused by gram-negative organisms, and although they presented with low effluent white cell counts on days 1 and 3, the risk for treatment failure in those episodes was not lower (adjusted odds ratio: 1.33; 95% confidence interval: 0.75 to 2.36; p = 0.33).♦ConclusionsSilent peritonitis is not a rare phenomenon, especially in older patients on PD. Although these episodes were more often culture-negative, silent presentation was not associated with a better outcome.

The clinical course of culture-negative peritonitis complicating peritoneal dialysis

2003 ◽  
Vol 42 (3) ◽  
pp. 567-574 ◽  
Author(s):  
Cheuk-Chun Szeto ◽  
Teresa Yuk-Hwa Wong ◽  
Kai-Ming Chow ◽  
Chi-Bon Leung ◽  
Philip Kam-Tao Li
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Course ◽  
Culture Negative
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